ACA Strategies

Access to Care May Come at a Premium

In the event of a provider shortage, payers may be compelled to shell out extra fees to get injured workers the treatment they need.
By: | March 14, 2014 • 3 min read

Workers’ compensation payers may spend more, post Patient Protection and Affordable Care Act, for injured worker access to physicians, speakers told the Workers Compensation Research Institute’s annual conference.

WCRI_logoBut paying more could improve claims outcomes, should a physician shortage become an issue.

While much remains unknown about the ACA’s ultimate impact, “evidence-based speculation” suggests that as the ACA restructures the country’s financing and delivery of health care, workers’ comp is unlikely to escape unscathed, Richard A. Victor, WCRI’s executive director said.

Potential impacts, such as a doctor shortage exacerbated by the ACA’s planned expansion of health care coverage for more Americans, will vary from state to state, depending on supply and demand factors, Victor told WCRI’s Annual Issues & Research Conference held March 12-13 in Boston.

Health care provider shortages are most likely in states with faster growing older populations, larger numbers of residents in poor health, and a greater expansion of health care coverage under the ACA.

Those factors will drive increased demand for health care services.

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Meanwhile, factors potentially limiting doctor supply include the average age of a state’s physician workforce, a smaller pipeline of new doctors to replace aging doctors, and workers’ comp fee schedules that deter medical providers’ desire to practice in a state.

“In states where there are lower fee schedules … those states will have a harder time competing for doctors, for retaining a high percentage of newly trained doctors,” Victor said.

“If there are doctor shortages, there is good reason to think that payers in this country would increase prices to get workers access to appropriate care.”
— Richard A. Victor, executive director, WCRI

The health care system is likely to adjust to a physician shortage by increasing use of “non-doctors” such as nurse practitioners and physician assistants.

“I think this is probably the single most important way the system will adjust, that and raising prices,” Victor said.

When it comes to competing for doctors, workers’ comp already pays more in most states for physician services than do other payers, he added. Meanwhile, most of the increase in demand for doctors is expected to come from Medicaid’s expansion and Medicaid typically offers the lowest reimbursement for medical providers.

“Workers’ comp may not be at a disadvantage in states that have those configurations,” he said. “And most state laws don’t say ‘You can’t pay more than the [workers’ comp] fee schedule if the fee schedule is a barrier to getting access to care.’ ”

Canada’s single-payer system provides an example of how U.S. workers’ comp payers may react to get injured employees the right care at the right time should doctor shortages become an issue here, according to Victor.

Workers’ comp payers in Canada pay additional amounts to allow injured workers to “jump the line” and avoid long wait times typically required to see a doctor in that country, he said.

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“If there are doctor shortages, there is good reason to think that payers in this country would increase prices to get workers access to appropriate care,” Victor said.

Paying more up front to push a worker through the process is preferable when it results in better outcomes, Donald C. Hurter, senior VP of Global Medical Management Services for American International Group told the conference.

But he also advised payers to collect data on medical providers in order to foster close relations with smaller networks of providers producing the best outcomes.

“The idea here is when we are looking at outcomes based networks it’s not about the dollar all the time,” Hurter said. “It’s about the outcome of the claim.”

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

Risk Matrix: Presented by Liberty Mutual Insurance

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The R&I Editorial Team can be reached at [email protected]